中低位局部进展期直肠癌术前采用新辅助放化疗和全程新辅助治疗的近期疗效与安全性

目的观察中低位局部进展期直肠癌术前采用新辅助放化疗(nCRT)与全程新辅助治疗(TNT)的近期疗效及安全性。方法前瞻性选取2016年12月至2018年10月河北北方学院附属第一医院收治的100例中低位局部进展期直肠癌患者为研究对象,按照随机数字表法将其分为nCRT组(放疗期予以口服卡培他滨治疗)和TNT组(放疗前予以奥沙利铂+卡培他滨Cape OX治疗),每组各50例,2组治疗后均予以全直肠系膜切除术治疗。比较2组患者的近期疗效、并发症、局部复发与转移率、术后生存率等。结果TNT组治疗4个月的总有效率(72.00%)明显高于nCRT组(42.00%),差异有统计学意义(P<0.05);术后2组并发症发生率(12.00%vs.10.00%)以及局部复发率(8.00%vs.10.00%)相比较,差异均无统计学意义(P>0.05);TNT组患者术后2年的临床转移率(10.00%)明显低于nCRT组(30.00%),而总生存率(94.00%)则显著高于对照组(78.00%),差异均有统计学意义(P<0.05)。结论相对于nCRT,术前予以TNT模式治疗中低位局部进展期直肠癌的近期疗效较高,并发症未见增加,安全性与总生存率较高,在应用及推广方面具有较大的优势。

Short-term efficacy and safety of preoperative neoadjuvant chemoradiotherapy and whole-course neoadjuvant therapy for low-and medium-level locally advanced rectal cancer

Objective To observe the short-term efficacy and safety of preoperative neoadjuvant chemoradiotherapy(nCRT) and whole-course neoadjuvant therapy(TNT) in the treatment of rectal cancer(medium-low local advanced stage),so as to provide basis for the treatment and research of clinical rectal cancer. Methods Prospectively selected 100 patients with middle and low locally advanced rectal cancer admitted to the First Affiliated Hospital of Hebei North University from December 2016 to October 2018 as the research objects,according to the random number table,they were divided into nCRT group(orally treated with capecitabine during radiotherapy) and TNT group(treated with oxaliplatin + capecitabine CapeOX before radiotherapy),50 cases in each group,and both groups after treatment was treated with total mesorectal resection. The short-term efficacy,complications,local recurrence and metastasis rates,and postoperative survival rates of the two groups were compared. Results The total effective rate of treatment for 4 months in the TNT group(72. 00%) was significantly higher than that in the nCRT group(42. 00%),and the difference was statistically significant(P < 0. 05);the postoperative complication rate(12. 00% vs. 10. 00%) and local Compared with the recurrence rate(8. 00% vs. 10. 00%),the difference was not statistically significant(P > 0. 05);the clinical metastasis rate(10. 00%) of patients in the TNT group was significantly lower than that in the nCRT group(30. 00%) at 2 years after surgery. The overall survival rate(94. 00%) was significantly higher than that of the control group(78. 00%),and the difference was statistically significant(P< 0. 05). Conclusion Compared with nCRT,preoperative TNT therapy has a higher short-term curative effect in the treatment of middle and low locally advanced rectal cancer,with no increase in complications,higher safety and overall survival,and has greater advantages in application and promotion.